{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T14:27:10Z","timestamp":1773844030584,"version":"3.50.1"},"reference-count":33,"publisher":"Journal of Graduate Medical Education","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To demonstrate a methodology for coding and taxonomy development and to operationally define residents' competence in systems-based practice (SBP) in terms of observable roles, actions, and behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The Accreditation Council for Graduate Medical Education's (ACGME's) full-text definition of SBP and the 6 discrete expectations it contains were content analyzed. Structured interviews of 88 health care professionals using a variant of focus group interviews called\n                      <jats:italic>nominal group processes<\/jats:italic>\n                      were conducted and qualitatively analyzed to identify the key attributes of SBP. Themes obtained from these 2 procedures were conceptually matched and organized to create a taxonomy of observable SPB behaviors and the SBP domain.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six general resident roles emerged, under which 35 specific behavioral attributes were subsumed. From the SBP domain specified. Sample SBP items categorized by roles were derived that reflected \u201cin-context\u201d representations of ACGME SBP expectations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our comprehensive analysis created an operational representation of the SBP competency. The taxonomy development model provides a framework for constructing assessment instrument(s) that could be applied to the other ACGME competencies or complex concepts in medical education.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4300\/01.01.0009","type":"journal-article","created":{"date-parts":[[2009,10,21]],"date-time":"2009-10-21T16:41:25Z","timestamp":1256143285000},"page":"49-60","source":"Crossref","is-referenced-by-count":37,"title":["Systems-Based Practice Defined: Taxonomy Development and Role Identification for Competency Assessment of Residents"],"prefix":"10.4300","volume":"1","author":[{"given":"Mark J.","family":"Graham","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoon","family":"Naqvi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Encandela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelli J.","family":"Harding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madhabi","family":"Chatterji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2856","reference":[{"issue":"17","key":"i1949-8357-1-1-49-Iglehart1","series-title":"N Engl J Med","first-page":"1693","article-title":"The struggle for reform\u2013challenges and hopes for comprehensive health care legislation.","volume":"360","author":"Iglehart, J. K.","year":"2009","unstructured":"Iglehart, J. K.\n          \n          The struggle for reform\u2013challenges and hopes for comprehensive health care legislation.\n          N Engl J Med\n          2009. 360 (17):1693\u20131695."},{"issue":"1","key":"i1949-8357-1-1-49-Public1","series-title":"Ann Intern Med","first-page":"55","article-title":"Achieving a high-performance health care system with universal access: what the United States can learn from other countries.","volume":"148","author":"Ginsburg, J. A.","year":"2008","unstructured":"Ginsburg, J. A. and R. B.Doherty. Public Policy Committee of the American College of PhysiciansAchieving a high-performance health care system with universal access: what the United States can learn from other countries.Ann Intern Med2008. 148 (1):55\u201375."},{"issue":"2","key":"i1949-8357-1-1-49-Graham1","series-title":"Adv Health Sci Educ Theory Pract","first-page":"187","article-title":"What indicates competency in systems based practice?: an analysis of perspective consistency among healthcare team members.","volume":"14","author":"Graham, M. J.","year":"2009","unstructured":"Graham, M. J., Z.Naqvi, and J.Encandela. What indicates competency in systems based practice?: an analysis of perspective consistency among healthcare team members.Adv Health Sci Educ Theory Pract2009. 14 (2):187\u2013203."},{"key":"i1949-8357-1-1-49-Institute1","series-title":"Crossing the Quality Chasm: A New Health System for the 21st Century","year":"2001","unstructured":"Institute of Medicine, Committee on Quality of Health Care in America\n          \n          Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DCNational Academy Press. 2001."},{"issue":"9292","key":"i1949-8357-1-1-49-Lancet1","series-title":"Lancet","first-page":"1471","article-title":"Educating doctors for world health.","volume":"358","year":"2001","unstructured":"Lancet\n          \n          Educating doctors for world health.\n          Lancet\n          2001. 358 (9292):1471."},{"key":"i1949-8357-1-1-49-Owen1","series-title":"Global Health","first-page":"12","article-title":"Globalization, health, and foreign policy: emerging linkages and interests.","volume":"1","author":"Owen, J. W.","year":"2005","unstructured":"Owen, J. W. and O.Roberts. Globalization, health, and foreign policy: emerging linkages and interests.Global Health2005. 1:12. Available at: http:\/\/www.globalizationandhealth.com\/content\/1\/1\/12. Accessed August 18, 2009."},{"issue":"6","key":"i1949-8357-1-1-49-Palmer1","series-title":"Occup Med (Lond)","first-page":"341","article-title":"Good medical practice: guidance for occupational physicians.","volume":"52","author":"Palmer, K. T.","year":"2002","unstructured":"Palmer, K. T., C. C.Harling, J.Harrison, E. B.Macdonald, and D. C.Snashall. Good medical practice: guidance for occupational physicians.Occup Med (Lond)2002. 52 (6):341\u2013352."},{"key":"i1949-8357-1-1-49-Romanow1","series-title":"Building on Values: The Future of Health Care in Canada","author":"Romanow, R. J.","unstructured":"Romanow, R. J.\n          \n          Building on Values: The Future of Health Care in Canada. Saskatoon, CanadaCommission on the Future of Health Care in Canada. Available at: http:\/\/www.cbc.ca\/healthcare\/final_report.pdf. Accessed August 18, 2009."},{"key":"i1949-8357-1-1-49-Ludmerer1","series-title":"Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care","author":"Ludmerer, K. M.","year":"1999","unstructured":"Ludmerer, K. M.\n          \n          Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. New York, NYOxford University Press. 1999."},{"key":"i1949-8357-1-1-49-ACGME1","article-title":"ACGME outcomes project.","year":"2009","unstructured":"ACGME\n          \n          ACGME outcomes project.\n          Available at: http:\/\/www.acgme.org\/outcome\/comp\/GeneralCompetenciesStandards21307.pdf. Accessed August 27. 2009."},{"key":"i1949-8357-1-1-49-The1","series-title":"The CanMEDS Physician Competency Framework","year":"2008","unstructured":"The Royal College of Physicians and Surgeons of Canada\n          \n          The CanMEDS Physician Competency Framework\n          Available at: http:\/\/rcpsc.medical.org\/canmeds\/index.php. Accessed July 31. 2008."},{"key":"i1949-8357-1-1-49-The2","series-title":"Good Medical Practice","unstructured":"The General Medical Council\n          \n          Good Medical Practice\n          Available at: http:\/\/www.gmc-uk.org\/guidance\/good_medical_practice\/GMC_GMP.pdf. Accessed August 18, 2009."},{"key":"i1949-8357-1-1-49-DeVellis1","series-title":"Scale Development: Theory and Applications","author":"DeVellis, R. F.","year":"1991","unstructured":"DeVellis, R. F.\n          \n          Scale Development: Theory and Applications. Newbury Park, CASage Publications. 1991. Applied Social Research Methods Series; vol 26."},{"issue":"3","key":"i1949-8357-1-1-49-Roe1","series-title":"Eur Psychol","first-page":"192","article-title":"What makes a competent psychologist?","volume":"7","author":"Roe, R. A.","year":"2002","unstructured":"Roe, R. A.\n          \n          What makes a competent psychologist?\n          Eur Psychol\n          2002. 7 (3):192\u2013202."},{"issue":"5\u20136","key":"i1949-8357-1-1-49-Bashook1","series-title":"Adm Policy Ment Health","first-page":"563","article-title":"Best practices for assessing competence and performance of the behavioral health workforce.","volume":"32","author":"Bashook, P. G.","year":"2005","unstructured":"Bashook, P. G.\n          \n          Best practices for assessing competence and performance of the behavioral health workforce.\n          Adm Policy Ment Health\n          2005. 32 (5\u20136):563\u2013592."},{"issue":"6","key":"i1949-8357-1-1-49-Wiggins1","series-title":"Educ Res","first-page":"20","article-title":"Research news and comments: response to Terwillinger.","volume":"27","author":"Wiggins, G.","year":"1998","unstructured":"Wiggins, G.\n          \n          Research news and comments: response to Terwillinger.\n          Educ Res\n          1998. 27 (6):20\u201321."},{"key":"i1949-8357-1-1-49-Trochim1","series-title":"The Research Methods Knowledge Base. 2nd ed","author":"Trochim, W.","year":"2000","unstructured":"Trochim, W.\n          \n          The Research Methods Knowledge Base. 2nd ed. Cincinnati, OHAtomic Dog Publishing. 2000."},{"issue":"3","key":"i1949-8357-1-1-49-Zhang1","series-title":"J Biomed Inform","first-page":"193","article-title":"A cognitive taxonomy of medical errors.","volume":"37","author":"Zhang, J.","year":"2004","unstructured":"Zhang, J., V. L.Patel, T. R.Johnson, and E. H.Shortliffe. A cognitive taxonomy of medical errors.J Biomed Inform2004. 37 (3):193\u2013204."},{"key":"i1949-8357-1-1-49-Chatterji1","series-title":"Designing and Using Tools for Educational Assessment","author":"Chatterji, M.","year":"2003","unstructured":"Chatterji, M.\n          \n          Designing and Using Tools for Educational Assessment. Boston, MAAllyn and Bacon. 2003."},{"issue":"4","key":"i1949-8357-1-1-49-Bordage1","series-title":"Med Educ","first-page":"312","article-title":"Conceptual frameworks to illuminate and magnify.","volume":"43","author":"Bordage, G.","year":"2009","unstructured":"Bordage, G.\n          \n          Conceptual frameworks to illuminate and magnify.\n          Med Educ\n          2009. 43 (4):312\u2013319."},{"key":"i1949-8357-1-1-49-American1","series-title":"Standards for Educational and Psychological Testing","year":"1999","unstructured":"American Educational Research Association\n          \n          Standards for Educational and Psychological Testing. Washington, DCAmerican Psychological Association. 1999."},{"key":"i1949-8357-1-1-49-Strauss1","series-title":"Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd ed","author":"Strauss, A. L.","year":"1998","unstructured":"Strauss, A. L. and J. M.Corbin. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd ed. Thousand Oaks, CASage Publications. 1998."},{"key":"i1949-8357-1-1-49-Glaser1","series-title":"Basics of Grounded Theory Analysis: Emergence vs. Forcing","author":"Glaser, B. G.","year":"1992","unstructured":"Glaser, B. G.\n          \n          Basics of Grounded Theory Analysis: Emergence vs. Forcing. Mill Valley, CASociology Press. 1992."},{"issue":"8","key":"i1949-8357-1-1-49-Tomolo1","series-title":"J Gen Intern Med","first-page":"769","article-title":"The Outcomes Card: development of a systems-based practice educational tool.","volume":"20","author":"Tomolo, A.","year":"2005","unstructured":"Tomolo, A., A.Caron, M. L.Perz, T.Fultz, and D. C.Aron. The Outcomes Card: development of a systems-based practice educational tool.J Gen Intern Med2005. 20 (8):769\u2013771."},{"issue":"2","key":"i1949-8357-1-1-49-Englander1","series-title":"Teach Learn Med","first-page":"150","article-title":"Teaching residents systems-based practice through a hospital cost-reduction program: a \u201cwin-win\u201d situation.","volume":"18","author":"Englander, R.","year":"2006","unstructured":"Englander, R., W.Agostinucci, E.Zalneraiti, and C. L.Carraccio. Teaching residents systems-based practice through a hospital cost-reduction program: a \u201cwin-win\u201d situation.Teach Learn Med2006. 18 (2):150\u2013152."},{"key":"i1949-8357-1-1-49-Schattner1","series-title":"BMC Health Serv Res","first-page":"21","article-title":"Information and shared decision-making are top patients' priorities.","volume":"6","author":"Schattner, A.","year":"2006","unstructured":"Schattner, A., A.Bronstein, and N.Jellin. Information and shared decision-making are top patients' priorities.BMC Health Serv Res2006. 6:21. Available at: http:\/\/www.biomedcentral.com\/1472-6963\/6\/21. Accessed August 18, 2009."},{"issue":"1","key":"i1949-8357-1-1-49-Baker1","series-title":"J Med Libr Assoc","first-page":"78","article-title":"Information needs at the end of life: a content analysis of one person's story.","volume":"92","author":"Baker, L. M.","year":"2004","unstructured":"Baker, L. M.\n          \n          Information needs at the end of life: a content analysis of one person's story.\n          J Med Libr Assoc\n          2004. 92 (1):78\u201382."},{"issue":"6","key":"i1949-8357-1-1-49-Ginsburg1","series-title":"Acad Med","first-page":"516","article-title":"The anatomy of the professional lapse: bridging the gap between traditional frameworks and students' perceptions.","volume":"77","author":"Ginsburg, S.","year":"2002","unstructured":"Ginsburg, S., G.Regehr, D.Stern, and L.Lingard. The anatomy of the professional lapse: bridging the gap between traditional frameworks and students' perceptions.Acad Med2002. 77 (6):516\u2013522."},{"issue":"1","key":"i1949-8357-1-1-49-Ackerman1","series-title":"J Gen Intern Med","first-page":"27","article-title":"Critical events in the lives of interns.","volume":"24","author":"Ackerman, A.","year":"2009","unstructured":"Ackerman, A., M.Graham, H.Schmidt, D. T.Stern, and S. Z.Miller. Critical events in the lives of interns.J Gen Intern Med2009. 24 (1):27\u201332."},{"key":"i1949-8357-1-1-49-Cutler1","series-title":"Adv Health Sci Educ Theory Pract","article-title":"Discrediting the notion \u201cworking with \u2018crazies\u2019 will make you \u2018crazy\u2019\u201d: addressing stigma and enhancing empathy in medical student education.","author":"Cutler, J. L.","year":"2008","unstructured":"Cutler, J. L., K. J.Harding, and S. A.Mozian. Discrediting the notion \u201cworking with \u2018crazies\u2019 will make you \u2018crazy\u2019\u201d: addressing stigma and enhancing empathy in medical student education.Adv Health Sci Educ Theory Pract2008. In press."},{"issue":"1","key":"i1949-8357-1-1-49-Ziegelstein1","series-title":"Acad Med","first-page":"83","article-title":"\u201cThe mirror\u201d and \u201cthe village\u201d: a new method of teaching practice-based learning and improvement and systems-based practice.","volume":"79","author":"Ziegelstein, R. C.","year":"2004","unstructured":"Ziegelstein, R. C. and N. H.Fiebach. \u201cThe mirror\u201d and \u201cthe village\u201d: a new method of teaching practice-based learning and improvement and systems-based practice.Acad Med2004. 79 (1):83\u201388."},{"key":"i1949-8357-1-1-49-Eva1","series-title":"Adv Health Sci Educ","first-page":"19","article-title":"Using a sampling strategy to address psychometric challenges in tutorial-based assessments.","volume":"12","author":"Eva, K. W.","year":"2007","unstructured":"Eva, K. W., P.Solomon, and A. J.Nevelle. Using a sampling strategy to address psychometric challenges in tutorial-based assessments.Adv Health Sci Educ2007. 12:19\u201333."},{"issue":"10","key":"i1949-8357-1-1-49-Brennan1","series-title":"Acad Med","first-page":"S43","article-title":"Use of encounter cards for evaluation of residents in obstetrics.","volume":"72","author":"Brennan, B. G.","year":"1997","unstructured":"Brennan, B. G. and G. W.Norman. Use of encounter cards for evaluation of residents in obstetrics.Acad Med1997. 72 (10):S43\u2013S44."}],"container-title":["Journal of Graduate Medical Education"],"original-title":[],"link":[{"URL":"https:\/\/jgme.kglmeridian.com\/view\/journals\/jgme\/1\/1\/article-p49.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jgme.kglmeridian.com\/downloadpdf\/journals\/jgme\/1\/1\/article-p49.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jgme.kglmeridian.com\/downloadpdf\/journals\/jgme\/1\/1\/article-p49.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:31:10Z","timestamp":1761179470000},"score":1,"resource":{"primary":{"URL":"https:\/\/jgme.kglmeridian.com\/view\/journals\/jgme\/1\/1\/article-p49.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,9]]},"references-count":33,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.4300\/01.01.0009","relation":{},"ISSN":["1949-8357","1949-8349"],"issn-type":[{"value":"1949-8357","type":"electronic"},{"value":"1949-8349","type":"print"}],"subject":[],"published":{"date-parts":[[2009,9]]}}}